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Customer number: 21322 *rint Date: 2/16/2007
<br />Store number: 16639 trarratiree Phone: (916) 928-0641
<br />Batch number: 153 c*tttrtz Wholesaler: AMERISOURCEBERGEN-008
<br />Account number: 008-030510 Address: 1325 WEST STRIKER AVENUE
<br />Name: DEUEL VOCATIONAL SACRAMENTO, CA 95834
<br />INSTITUTION
<br />Credits passed through: 21322
<br />Customer reference number: GRX21322153
<br />Service Date: 01/22/2007
<br />Returnable Report
<br />NOVARTIS PHARM. (Direct) - -
<br />NOVO-NORDISK
<br />PADDOCK
<br />tea.. Drug Nama'.` Quantity " :Siza .` Strength N0CN0 ,
<br />.,
<br />ACTIDOSE W/ SORBITOL 1.000 1.00 00674012074 " 9.59
<br />ACTIDOSE W/ SORBITOL .1.000 1.00 00574012074 9.59
<br />Total: 2.000 19.18
<br />PAR PHARM
<br />PERRIGO,L.
<br />Name,,. .. . ;Quantity
<br />-; Stze ": 11,,,: . ,
<br />""'i. NOCNU �� lass
<br />PrJce s d a
<br />VOLTAREN OPHTHALMIC
<br />1.000
<br />1.00 0.1 %
<br />58768010005 R
<br />54.09
<br />VOLTAREN OPHTHALMIC
<br />1.000
<br />1.00 0.1 %
<br />58768010005 R
<br />54.09
<br />1.000
<br />Total: 2.0001
<br />1
<br />1 1
<br />108.18
<br />NOVO-NORDISK
<br />PADDOCK
<br />tea.. Drug Nama'.` Quantity " :Siza .` Strength N0CN0 ,
<br />.,
<br />ACTIDOSE W/ SORBITOL 1.000 1.00 00674012074 " 9.59
<br />ACTIDOSE W/ SORBITOL .1.000 1.00 00574012074 9.59
<br />Total: 2.000 19.18
<br />PAR PHARM
<br />PERRIGO,L.
<br />PFIZER
<br />uantitY
<br />00121058104 R 12.00
<br />Total: 1 1.0001
<br />"Nq{SNxS
<br />12.00
<br />ZOLOFT
<br />PERMETHRIN
<br />1.000
<br />1.00
<br />5%
<br />45802026937
<br />R
<br />20.40
<br />PERMETHRIN
<br />1.000
<br />1.00
<br />5%
<br />45802026937
<br />R
<br />20.40
<br />PERMETHRIN
<br />1.000
<br />1.00
<br />5%
<br />45802026937
<br />R
<br />20.40
<br />PERMETHRIN
<br />1.000
<br />1.00
<br />5%
<br />45802026937
<br />R
<br />20.40
<br />PERMETHRIN
<br />1.000
<br />1.00
<br />5%
<br />45802026937
<br />R
<br />20.40
<br />Total:
<br />5.000
<br />102.00
<br />PFIZER
<br />PHARMACEUTICAL ASSC.
<br />Ruantity ,
<br />HALOPERIDOL ORAL SOLUTION 1.000 1.00
<br />uantitY
<br />00121058104 R 12.00
<br />Total: 1 1.0001
<br />"Nq{SNxS
<br />12.00
<br />ZOLOFT
<br />0.200
<br />50 00
<br />25 MG
<br />00049496050
<br />R 24.14
<br />NEURONTIN
<br />0.140
<br />100.00
<br />600 MG
<br />71051324
<br />R 33.05
<br />ZITHROMAX
<br />0.933
<br />30.00
<br />600 MG
<br />00069308030
<br />R 464.80.
<br />Total:
<br />-: 3.000
<br />R
<br />-
<br />CHLORPROPAMIDE
<br />521.99
<br />PHARMACEUTICAL ASSC.
<br />Ruantity ,
<br />HALOPERIDOL ORAL SOLUTION 1.000 1.00
<br />Strength
<br />2MG/ML
<br />00121058104 R 12.00
<br />Total: 1 1.0001
<br />NDCNiD
<br />12.00
<br />PLIVA INC
<br />Drug Name : r ��. . , _ `":
<br />; Quantity ;
<br />, Siza ,
<br />„- 'Streng£h ,
<br />NDCNiD
<br />:Class
<br />Price v
<br />HYDROXYZINE NCL
<br />0.500
<br />100.00
<br />10MG
<br />50111030701
<br />R
<br />19.25
<br />BENZTROPINE MESYLATE
<br />0.010
<br />1000.00
<br />1 MG
<br />50111039403
<br />R
<br />1.08
<br />CHLORPROPAMIDE
<br />0.100
<br />100.00
<br />100 MG
<br />50111037201
<br />R
<br />1.55
<br />CHLORPROPAMIDE
<br />1.000
<br />100.00
<br />100 MG
<br />50111037201
<br />R
<br />15.50
<br />Total:
<br />4.000
<br />37.38
<br />QUALITEST
<br />Oriig -Name
<br />-
<br />Quantity; Size . "" "
<br />.' Strength .. "
<br />NOCNO : "" .. Ciass
<br />R
<br />METHAZOLAMIDE
<br />tA00 100.00
<br />50 MG
<br />G0603447121 25.99
<br />Total:
<br />1.0001
<br />CIPROFLOXACIN 1.000 100.00
<br />1 25.99
<br />RANBAXY
<br />'%' ": , ", Drug Nama < ;:. . _ ,-; .:., Quantity, , " ;, Size ; .
<br />Strength
<br />NDCNQ .. ,,, , ,,",.'class']",
<br />XELODA 0.750 240.00
<br />FORTOVASE 0.972 180.00
<br />Price
<br />CIPROFLOXACIN 0.500 100.00
<br />250 MG
<br />63304070901
<br />R
<br />16.70
<br />CIPROFLOXACIN 1.000 100.00
<br />250 MG
<br />63304070901R
<br />10 MG
<br />33.40
<br />CIPROFLOXACIN 1.000 100.00!1
<br />250 MG
<br />63304070901
<br />R
<br />33.40
<br />Total: 3.000
<br />3.000
<br />83.50
<br />ROCHE/SYNTEX
<br />-,z:'-Drug Name-, ,: , .,, , . , ;,.., i " Quantity!]
<br />Quantity`
<br />Size . `"
<br />XELODA 0.750 240.00
<br />FORTOVASE 0.972 180.00
<br />500MG 1
<br />200MG
<br />00004110116 R 1889.36
<br />00004024648 R 204.78
<br />Total: 1 2.0001
<br />1 1
<br />1 2,094.14
<br />ROXANE
<br />Drug Name "
<br />Quantity`
<br />Size . `"
<br />`:. Strength",
<br />`:; "; , NDCNO , ..,,;� ': Glass "s. 'Price"_..
<br />PREDNISONE
<br />0.500
<br />100.00
<br />5 MG
<br />00054472825 R 1.48
<br />PREDNISONE
<br />0.010
<br />100.00
<br />10 MG
<br />00054473025 R 0.05
<br />LITHIUM CARBONATE
<br />0.750
<br />100.00
<br />150 MG
<br />00054252625 R 7.31
<br />Total:
<br />3.000
<br />8.84
<br />NY Division: 100 Colin Drive, Holbrook, NY 11741, Phone: 1-800-473-2138; Midwest Division: 100 Teduke Court, St Charles, MO 63301, Phone: 1-800-729-3279
<br />Page 4 of 11
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